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Oncology vs. Radiation Oncology

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Jccripe

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What exactly is the difference. I can infer from the name, but why have two seperate specialties?
 

QuantumMechanic

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Obviously radoncs use radiation to treat cancer, while medoncs use chemotherapy and other pharmaceutical modalities to treat cancer.

Radonc is a separate field since radiation is a great tool, but one that must be used with great care. Understanding the effects of radiation to healthy tissue and understanding how to use radiation to treat cancer is not a simple skill to acquire. Both need to know much about cancer (over on the radonc forum, they claim that radoncs are more knowledgable about cancer than medoncs).

Radoncs also use radiation occaisionally to treat benign conditions.
 

Spirog

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I used to work in an oncology (medonc) clinic (with an attached radonc clinic as well), so here's my experience:

As QM stated, medonc uses pharmaceutical and other modalities to treat cancer, while radoncs use radiation. Radoncs need to know a lot of physical science and how radiation affects biological tissues and such. If you ever read about the treatment of cancer with radiation, its much more complicated than one might assume (well more than I did, at least) and very different than most medical stuff I have read.

Now, as far as radoncs knowing more about cancer, I don't know if that's true or not, so I won't comment on that. But, in my opinion, the medoncs know way more about medicine in general than the radoncs. I say that because, in our clinic, the medoncs were responsible for pharmaceutical treatment AND symptom management for patients. Basically, people went to radonc to get zapped, then they came to the medoncs to deal with all the side-effects and to get their other treatment if necessary. I don't know if that's how it works at other clinics in general, so take that as you will. But one of the medoncs put the relationship pretty much like I did "Radonc zaps the patients and shuffle them out. We deal with them and the problems they have."

Just my 2 cents.
 

QuantumMechanic

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from the Radonc Forum faq's:

How do Med Onc (Heme Onc) and Rad Onc differ?
Erm, that?s more difficult to explain because you have to talk about care on difference levels: technical issues, suoppotive issues etc.. There are enormous differences but the particular features of those differences really vary depending upon what kind of disease you?re treating. In broad strokes; rad onc is more like surgery in the approach to what you do to treat the patient. You take the info regarding the anatomy, pathology, histology, stage, and prior treatment (i.e. surgery) of the disease as well as the other general host-related issues (i.e. co-morbidities), and make your plan taking these all into account in three-dimensional space. You might vary your plan if much normal tissue is in the field for instance. Med onc delivers chemo, a systemic drug, and is less reliant on ?technique?. Medical oncologists prescribe their drug and modify based on the response of the patient and their well-being in general throughout the care. In terms of training, medoncs do 3-4 years of internal medicine before their 2-3 years of fellowship. Rad onc involves one internship year followed by 4 years of radonc specialty training (i.e. mostly oncology related training). Radonc also involves small procedures.
 

Orthodoc40

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My radiation oncologist friend tells me that the medical oncologist manages the overall care of the patient - similar to your primary care doctor in that they make the plan for how they will treat the cancer being dealt with, they send the patient to the radiation oncologist if radiation therapy will be part of treatment. Once radiation treatment is complete, the patient will probably not go back to the radiation oncologist.

In that sense, she said, rad onc is similar to surgery - you treat for something specific, and you send the patient back where they came from because you are essentially done with them. The medical oncologist also is the one that has the difficult task of informing the patient of their diagnosis. Radonc rarely has to break any news like that, she said.
 

dilated

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Now, as far as radoncs knowing more about cancer, I don't know if that's true or not, so I won't comment on that. But, in my opinion, the medoncs know way more about medicine in general than the radoncs.

This seems like a fair breakdown. The radiation oncologists I've met are pretty much THE best versed on basic science and clinical literature of anybody in any specialty, not just oncology. They are all extremely smart. At tumor board they can take the med oncs and surgeons to school with the results of 700 different studies. But they don't know much (or care) about medical issues that do not directly relate to radiation therapy and they turf it all off at the first opportunity, whereas med oncs have to deal with and be up on all of that.
 

Jccripe

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So when RadOncs are compared to surgeons, how long does "blasting" the patient with Rad take. one hour, faster, longer?
 

Jccripe

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Thank you for all the feed back
 

QuantumMechanic

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So when RadOncs are compared to surgeons, how long does "blasting" the patient with Rad take. one hour, faster, longer?

This is an issue that is nonsignificant to the radiation oncologist. A specially trianed radiation therapist (not an MD) performs the radiotherapy (ie. the radonc isnt the 'button pusher'). The radiation oncologist merely prescribes the radiation and makes sure that the treatment plan created by the medical physicists and dositometrists is correct for the given situation. The radonc will need to confirm the appropriate placement of the patient by examining port films so its not as if he/she isnt present at all during this process, but its not as if he/she is sitting there as the radiation doses are delivered. I guess thats one of the reasons why its a "cush" specialty...the radoncs procedures arent time-consuming and they don't have inpatients to constantly monitor. When you combine that with regular work hours/work week, you can see why its much more popular than other specialties.

Each "blasting" is called a fraction and is usually no more than a half-hour. However, many fractions (spread over a several week period) are given.
 

Mixtli

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Radiation oncology is no joke. They got to be some of the smartest clinical docs I've encountered. Most of the attendings at non-private places are also conducting research and publishing articles in addition to their clinical work. As for the residents, they are probably reading and studying and oncology and physics literature and textbooks after their "regular" work schedule.

They got to be very well-versed in many different aspects:
1) Clinical oncology
2) Anatomy (for contouring, PET, CTs)
3) Physics (for patient setup) and different modalities of external beam therapy (3D conformal, IMRT, gamma knife) and the different complexities and challenges of each (arcs, blocks, wedges, tissue sparing, hot spots, organ motion)
4) Dosimetry
5) Small procedures such as brachytherapy, seed implanting

Though they do enjoy a "posh lifestyle" in general. They sometimes receive emergencies that require radiation right away (both oncology related and non-oncology).
 

QuantumMechanic

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As for the residents, they are probably reading and studying and oncology and physics literature and textbooks after their "regular" work schedule.

Yep! one resident I met was telling me about how she doesnt have as much free time during residency as she thought she would since she has to do so much reading during her offtime.
 

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Slightly off topic, but not too far...

Is the only way to become a medical oncologist to go through a residency in internal medicine and then a fellowship in a specific oncological modality?

Does the radiation oncologist go through a residency in internal med also?
 

QuantumMechanic

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Slightly off topic, but not too far...

Is the only way to become a medical oncologist to go through a residency in internal medicine and then a fellowship in a specific oncological modality?

Does the radiation oncologist go through a residency in internal med also?

1. Yes, IM then a Heme/Onc fellowship to do medical oncology

2. No, Radonc has its own residency program
 
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Llenroc

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(over on the radonc forum, they claim that radoncs are more knowledgable about cancer than medoncs).

That's a joke. Radiation oncologists only deal with a small number of cancers, whereas in hematology-oncology anyone who has trained has at least some exposure to all the major types of cancers, including those in which radiation has zero role.
 

I am Hans

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That's a joke. Radiation oncologists only deal with a small number of cancers, whereas in hematology-oncology anyone who has trained has at least some exposure to all the major types of cancers, including those in which radiation has zero role.

I laughed when I read that quote too...there ARE tumors that are radioinsensitive and for which the only current treatment is surgery, surgery plus (neo)adjuvant chemo or chemo alone.

But we should allow each group of specialists to have bragging rights in their own forums, if only to keep the peace!:laugh:
 

QuantumMechanic

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That's a joke. Radiation oncologists only deal with a small number of cancers, whereas in hematology-oncology anyone who has trained has at least some exposure to all the major types of cancers, including those in which radiation has zero role.


http://www.oncolink.upenn.edu/treatment/article.cfm?c=5&s=27&id=322

It is estimated that more than 50% of cancer patients will receive radiation at some point during their treatment.

Not really a small number of cancers?
 

Mixtli

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Despite it's name, radiation oncology also treat non-oncological cases as well. Maybe that 50% could go higher if not for the costs. I mean if a patient requires 30 fractions and each fraction costs $300. Someone is paying 30x300= 90K and that doesn't include the hospital related costs.
 

carrigallen

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In my limited experience:
Rad oncs usually
1. Having staging for ALL cancers (even fairly rare types) memorized.
2. Have recent clinical trials for all common cancers memorized (this entails knowing results of 200+ studies).
3. Do small procedures (laryngoscopy, seed implants, gamma knife, brachytherapy, wound care.)
4. Strong knowledge of anatomy.
5. Generally reimbursement is $300-600,000.

Med oncs usually
1. Experienced with end of life issues and palliative care
2. Experienced with treating the adverse effects of chemotherapy, particularly immunocompromised patients.
3. Do small procedures such as bone marrow biopsies and intrathecal chemotherapy.
4. Strong knowledge of hematopoesis, immunology.
5. Generally reimbursement is $250-350,000.
 

medanthgirl

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interestingly, rad oncs are starting to go into o.r. at some medical centers, as iort (inter-operative radiation therapy) is going through clinical trials. it's really cool - for a breast cancer patient, the first radiation treatment will be given when the patient is in the o.r. just after the cancer is removed, it's a way of targeting the margins that the surgeon just cut out. in those cases it is definately the rad onc doc doing the tx, not a rad tech.

and often times some patients will get all three (this is common for invasive breast cancers):surgery (surg onc), then chemo (med onc), then radiation therapy (rad onc). sometimes the order may be switched but each has a different 'type' of treatment to give.
 

jjmack

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The medical oncologist (3 years internal med residency plus oncology fellowship, typically hemonc) is the person I think of as the primary care doc for the cancer pt, as least as far as the cancer is concerned. It is one of the most competative internal med specialties.

Rad onc is very competative and is matched into out of med school (starting with PGY-2) because of the limited number of slots. Most would put it up there with dermatology.
Is heme/onc competitive? I know GI and cards are, but haven't heard of this about heme/onc.
 

mvenus929

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I just shadowed a radonc a couple weeks ago, so I thought I might give some input.

So when RadOncs are compared to surgeons, how long does "blasting" the patient with Rad take. one hour, faster, longer?

From what I've seen, the machine that delivers the radiation is only on for a minute or so each time radiation is delivered. It takes more time setting the machine up to deliver the radiation in the right place than it does to deliver the radiation itself. However, it usually requires several treatments. The breast cancer patients I saw had like 6 weeks of treatment. I think the prostate cancer patients had 2. There was a lung cancer patient that had 1 week, I think...

Once radiation treatment is complete, the patient will probably not go back to the radiation oncologist.

The one I shadowed follows up with all her patients. Once a year for older cancers, and once every 6 months or so for newer cancers. Since they also go see the medonc, they go in for followup about every 6 months. In fact, the day I was there, her entire afternoon was followups, and morning was consultants. I'm sure it's not like that every day (since she said she spends a lot of time in the physics department), but it seemed like a typical thing.
 

imable24

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Do you match for an oncology fellowship in medical school? Do people match for any internal medicine subspeciality fellowships while in school? How important are grades and step 1 score for fellowships? Are some some fellowships more competitive than others?

ETA: How do people become surgical oncologists? Do they do a general surgery residency and an oncology fellowship?
 

TRAMD

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Because I love both math and medicine I decided to rank 20 common specialties using median salaries (averaged from 7 sources of median salaries) and a subjective rating system of lifestyle. Sorry, don't have any fellowship specialties so no Med Onc.

Ranking of common specialties by salary and lifestyle. Specialties at the top have high salary to lifestyle ratio. Lifestyle determined by fewer and more controllable hours, less call, and less nights and weekends

1. Radiation Oncology
2. Dermatology (best lifestyle)
3. Radiology
4. Pathology
5. Physiatry
6. Psychiatry
7. Plastic Surgery (most competitive)
8. Neurosurgery (highest salary)
9. Neurology
10. Ophthalmology
11. Emergency Med
12. Anesthesiology
13. ENT
14. Orthopedic Surgery
15. OB/Gyn
16. Urology
17. Pediatrics
18. Family Medicine (lowest salary)
19. General Surgery (worst lifestyle)
20. Internal Medicine (least competitive)

Radiation oncology is a great field to go into if you are competitive enough and have an interest in oncology, physics and technology.

BTW - I am going into physiatry, I don't like cancer.
 
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-Goose-

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Because I love both math and medicine I decided to rank 20 common specialties using median salaries (averaged from 7 sources of median salaries) and a subjective rating system of lifestyle. Sorry, don't have any fellowship specialties so no Med Onc.

Ranking of common specialties by salary and lifestyle. Specialties at the top have high salary to lifestyle ratio. Lifestyle determined by fewer and more controllable hours, less call, and less nights and weekends

1. Radiation Oncology
2. Dermatology (best lifestyle)
3. Radiology
4. Pathology
5. Physiatry
6. Psychiatry
7. Plastic Surgery (most competitive)
8. Neurosurgery (highest salary)
9. Neurology
10. Ophthalmology
11. Emergency Med
12. Anesthesiology
13. ENT
14. Orthopedic Surgery
15. OB/Gyn
16. Urology
17. Pediatrics
18. Family Medicine (lowest salary)
19. General Surgery (worst lifestyle)
20. Internal Medicine (least competitive)

Radiation oncology is a great field to go into if you are competitive enough and have an interest in oncology, physics and technology.

BTW - I am going into physiatry, I don't like cancer.

Urology should be MUCH higher on this list.
 

TRAMD

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Urology should be MUCH higher on this list.

Median salary for Urology is below Neurosurgery, Ortho, Rad Onc, Plastic Surgery, and Radiology. Also be aware that there is a subjective component to this and from my point of view Urology has a very poor lifestyle with many hours worked and frequent call due to the severe shortage of urologists. My goal was to rank "lifestyle" specialties with good salaries. Urology could probably move up a few spaces, but is not a "lifestyle" specialty and you would have a hard time convincing me it should be in the top 10. Again, the subjective component does make room for error and your opinion is as good as mine.
 

Orthodoc40

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The one I shadowed follows up with all her patients. Once a year for older cancers, and once every 6 months or so for newer cancers. Since they also go see the medonc, they go in for followup about every 6 months. In fact, the day I was there, her entire afternoon was followups, and morning was consultants. I'm sure it's not like that every day (since she said she spends a lot of time in the physics department), but it seemed like a typical thing.

Fair enough. The one I shadowed told me that once their treatment is complete, the remainder of follow up goes to the medical oncologist. I was just going by what she told me but it must be different in different places.
 

carrigallen

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I think it is odd that you have Urology down on the list, especially below Obstetrics and ER medicine. The lifestyle of a urologist is great - there are really no true urologic emergencies besides torsed testes and fournier's gangrene. The compensation for urology is excellent. It is the #1 most satisified specialty according to the USnews survey.
Also, I think the compensation for plastic surgery compares favorably to neurologic surgery.
 

smq123

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Do you match for an oncology fellowship in medical school?

No. You can apply for fellowships while in residency, but not before.

Do people match for any internal medicine subspeciality fellowships while in school?

No.

How important are grades and step 1 score for fellowships?

Not sure, but they definitely affect where you do internship and residency, which can affect your fellowship application.

Are some some fellowships more competitive than others?

Yes. GI and cardiology are very, very competitive.

How do people become surgical oncologists? Do they do a general surgery residency and an oncology fellowship?

Yes.
 

PeepshowJohnny

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It's PM & R, I think.

I do believe you are correct. I think it's more of an older term, but still thrown around.

I think it is odd that you have Urology down on the list, especially below Obstetrics and ER medicine. The lifestyle of a urologist is great - there are really no true urologic emergencies besides torsed testes and fournier's gangrene. The compensation for urology is excellent. It is the #1 most satisified specialty according to the USnews survey.

I think penile fractures count too for urological emergencies. That said, the urologist I spoke too echoed the same thing, lifestyle is urology is fantastic. He's said nurses love when he's on call because he's willing to come in for things other urology docs try to weasle their way out of seeing until tomorrow, like the guy who they just couldn't place a Foley in. ER has its lifestyle aspects too, but Obstetrics is absolutely one of the worst lifestyle fields.
 

VCMM414

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Not in neurology myself, but have been told by neuro residents that it is a less competitive match than IM. I would have guessed that they were comparable in difficulty.

Also, FM and OB more competitive than IM? Hard to believe... Then again, there are tons of IM spots out there...
 

Taurus

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Back to the original question of onc vs. radonc, I'm surprised that no one has brought up the subject of reimbursement cuts to onc. Maybe no one here is aware of it. CMS cut reimbursements by 30% starting last year for onc. An internist I was working with told me that he knows several private practice onc's who are leaving the field altogether and dumping their patients onto hospitals.

I keep hammering home the point: don't forget about the economics when you make your career decisions.
 

PeepshowJohnny

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Back to the original question of onc vs. radonc, I'm surprised that no one has brought up the subject of reimbursement cuts to onc. Maybe no one here is aware of it. CMS cut reimbursements by 30% starting last year for onc. An internist I was working with told me that he knows several private practice onc's who are leaving the field altogether and dumping their patients onto hospitals.

I keep hammering home the point: don't forget about the economics when you make your career decisions.

Economics are important, but how are we supposed to foresee the future?
 
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howelljolly

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Based on what I got from the Rad-Onc I know:

Rad-Onc is a lifestyle specialty (9-5, no nights/weekends/holidays). They make a boatload of money and will have to follow their patients for life, to monitor for complications. They need to know everything about every "solid" tumor, and know a lot of extra physics (as expected), and know anatomy really well. As an oncologists they need to follow exactly what their Heme-Onc is doing.

Heme-Oncs are fellowship trained Internists. Having the IM training, they have to do the total patient care thing, prescribe the anti-tumor agents, and coordinate the team. In their fellowship, they need to learn everything about every tumor, as well as all of Hematology.
 

BORNagainSTDENT

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I think it is odd that you have Urology down on the list, especially below Obstetrics and ER medicine. The lifestyle of a urologist is great - there are really no true urologic emergencies besides torsed testes and fournier's gangrene. The compensation for urology is excellent. It is the #1 most satisified specialty according to the USnews survey.
Also, I think the compensation for plastic surgery compares favorably to neurologic surgery.


How hard is urology to get.
 

DrZeke

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Not in neurology myself, but have been told by neuro residents that it is a less competitive match than IM. I would have guessed that they were comparable in difficulty.

Also, FM and OB more competitive than IM? Hard to believe... Then again, there are tons of IM spots out there...
When referring to competitive - most people are talking about board scores and then research and so on. The problem with IM is that if you go to a better ranked program then you have better chances of matching into more competitive fellowships at better institutions. So, while IM in general might not be competitive, it can be quite competitive when you're trying to find the better programs.
 

howelljolly

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How hard is urology to get.

Very competitive. They also have their own separate match. Great field in my opinion. They've got it all, medical management, surgery, oncology, infections, peds, adults, males, females...
 

meister

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Rad Onc always sounded like the bee's knees to me but you pretty much have to get published in med school to even have a shot at matching. And I hate research, so that's a no-go at this point unless I find some major motivation by pulling it out of my rectum. Not likely to happen.
 

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So let me get this straight.

1. As a radiation on oncologist, you have to be super smart and know a ton of stuff.

2. You don't have to actually do the boring procedures - radiation physicists do that. Only the interesting ones. Versus, say, a neurosurgeon who might also do neat stuff but has to stand there for hours while grinding through bone and other boring parts.

3. You don't have to actually watch people die from cancer - you try to stop the tumor with radiation, but, either way you send the patient back to the med onc.

4. You get paid more money for less hours, giving you more time to enjoy said money with fun stuff.

So what exactly is the downside? Other than the fact that the majority of medical students will not have the numbers and research needed to match it. Oh, and radiation is scary stuff - but you stand behind a nice thick lead wall when the power is on to the radiation machine.
 
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Narmerguy

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So do RadOncs have any kind of meaningful contact with their patients at all? Because it seems that as far as the patient is concerned a computer could be delivering the treatment and they wouldn't know the difference.
 

Green Mountains

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Hello everyone,

I have a quick question for anyone in the oncology specialty.

First, I am currently finishing up my masters degree in acupuncture and oriental medicine and planned on going on to complete my doctoral degree (DAOM) a clinical doctoral degree for acupuncturists. This will be another two years of study. I was thinking of going to Bastyr in Seattle, due to the program specialty in supportive oncology, supportive cancer care training for (acupuncturists). It seems pretty intense and you get to do clinical training at some top cancer hospitals.

My reasons are personal for wanting to work with cancer patients and I know I would really enjoy doing this.

My question is, what type of reception would I get from oncologists as a acupuncturists that specializes in helping treat the side effects of cancer treatment? Do you think any oncologists would be willing/interested in either renting space out to me in their practice or possibly hiring me to work for them?

I have maintained a 3.92 to 4.0 GPA throughout college and throughout acupuncture and oriental medicine school. The AOM master program is 4 years and the Doctoral is an additional 2 years. My total college after would be 10 years if include undergrad.

If anyone could help me with my questions and give me some ideas and what you think about this, I would be truly grateful.

Sorry if my post is in the wrong area.
 
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fahimaz7

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Acupuncture is for quacks! Jk.. I have never had it done.

On a side note, you don't have to do the Hem part of the fellowship to be a med onc. Med Onc and Hemotology, by themselves, is a 2 year fellowship and when they are combined = a 3 year fellowship. How do I know this? One of the Oncologists that I work with on a daily basis did the 2 year Med-Onc fellowship instead of the 3-year, combined program.
 

mikedc813

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So do RadOncs have any kind of meaningful contact with their patients at all? Because it seems that as far as the patient is concerned a computer could be delivering the treatment and they wouldn't know the difference.

There is a lot of patient contact in rad onc. Each patient is different and requires different treatment planning. Everyone with prostate cancer doesn't get the same exact treatment, for example. There are weekly on-treatment visits when the patient checks in with the radiation oncologist during treatment (which usually lasts several weeks) to report any problems. There is also follow up post-radiation therapy. There is plenty of patient interaction, which is one of the reasons why I chose rad onc.
 

howelljolly

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Hello everyone,

I have a quick question for anyone in the oncology specialty.

First, I am currently finishing up my masters degree in acupuncture and oriental medicine and planned on going on to complete my doctoral degree (DAOM) a clinical doctoral degree for acupuncturists. This will be another two years of study. I was thinking of going to Bastyr in Seattle, due to the program specialty in supportive oncology, supportive cancer care training for (acupuncturists). It seems pretty intense and you get to do clinical training at some top cancer hospitals.

My reasons are personal for wanting to work with cancer patients and I know I would really enjoy doing this.

My question is, what type of reception would I get from oncologists as a acupuncturists that specializes in helping treat the side effects of cancer treatment? Do you think any oncologists would be willing/interested in either renting space out to me in their practice or possibly hiring me to work for them?

I have maintained a 3.92 to 4.0 GPA throughout college and throughout acupuncture and oriental medicine school. The AOM master program is 4 years and the Doctoral is an additional 2 years. My total college after would be 10 years if include undergrad.

If anyone could help me with my questions and give me some ideas and what you think about this, I would be truly grateful.

Sorry if my post is in the wrong area.

It depends.

It depends on the individual oncologist, the culture in the oncology practice that you work with, the patient population, the hospitals... etc. etc. Most MDs dont know anything about what you are doing, so they'll either suspend disbelief, and let you do your thing....or they'll think you are a quack.

Your philisophy or paradigm of the disease process is different from the allopathic/oncologic paradigm. Your Oncology colleagues will explain the side effects and symptoms of cancer with stories like "the massive destruction of tumor cells releases intracellular products in circulation..." or "the rapidly growing tumor is stretching the capsule of the liver and causing pain...." If you explain the same things in different terms, naturally, there will be disagreement.

So, you'll have oncologists who think you are wrong because your fundamental concepts are incorrect ergo, your final arument is incorrect...

But, find a place that has oncologists and a population that are willing to try traditional medicine out, and you should be OK.
 

nogolfinsnow

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Acupuncture is for quacks! Jk.. I have never had it done.

On a side note, you don't have to do the Hem part of the fellowship to be a med onc. Med Onc and Hemotology, by themselves, is a 2 year fellowship and when they are combined = a 3 year fellowship. How do I know this? One of the Oncologists that I work with on a daily basis did the 2 year Med-Onc fellowship instead of the 3-year, combined program.

Yeah, for adult you are either onc or heme or you get board certified in both. In peds, it is a heme/onc combined fellowship.

We had once lecture from a rad-onc earlier this year. I thought she was great and had a fair amount of patient interaction while patients were undergoing their treatments. In some cases, patients received radiation 5 days a week for 8 weeks. I personally am not very good at any physics past free body diagrams, but I think radonc is a cool field.
 

Lawgiver

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so rad onc are less likely to deal with people at eol compared to med onc?
 

Winged Scapula

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so rad onc are less likely to deal with people at eol compared to med onc?
I'm not sure about that; there are lots of indications for palliative radiation for end stage diseases.
 
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Smurfette

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so rad onc are less likely to deal with people at eol compared to med onc?

not quite as many, but XRT for palliation of symptoms and treatment of disease occurs at EOL as well. They also will consult on EOL patients who may or may not qualify for XRT (already maxed out how much radiation they can have or simply not a problem/location that XRT would help, etc.). Keep in mind that essentially all their patients have cancer, so if dealing with death and dying is tough for you, it may be a tough field for you as well.
 
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Lawgiver

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I'm hoping it is something I will just get used as time passes.
 
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